Medical Claim Analyst

CVS Health Careers

. Conduct initial review and triage of claims assigned for review .

Posted 11/12/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in claims review and triage, ensuring compliance with regulatory standards while maintaining accurate documentation. Exhibits strong communication and customer service skills to enhance healthcare team effectiveness and resolve claims payment issues.

Highest-signal resume keywords

Claims Review and TriageMedical Terminology FamiliarityCustomer Service SkillsMicrosoft Office 365 ProficiencyRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingDocumentation ManagementMedical Research SupportTechnical TroubleshootingEligibility Verification

Soft Skills

Effective CommunicationOrganizational SkillsAttention to DetailProactive Issue ResolutionOpenness to Learning

Tools & Technologies

Microsoft ExcelMicrosoft WordVPN AccessEHR PortalsTeams Messaging

Certifications & Qualifications

High School DiplomaG.E.D.

Industry Keywords

Healthcare ManagementHIPAA ComplianceRisk ManagementAccreditation StandardsClaims Payment Issues

About the role

Key responsibilities & impact

Conduct initial review and triage of claims assigned for review
Determine coverage and verify eligibility
Identify and redirect misdirected claims
Prepare authorizations in the system
Triage cases to medical staff for review
Organize and prioritize work to meet regulatory and claim turnaround times
Promote internal and external communication to enhance medical management services and healthcare team effectiveness
Perform non-medical research and support
Comply with PM policies and regulatory standards
Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
Protect member confidentiality and follow company confidentiality policies
Assist in researching and resolving claims payment issues

Requirements

What you’ll need

Effective communication, telephonic and organization skills
Familiarity with basic medical terminology and concepts used in care
Strong customer service skills, including attention to customers, sensitivity to issues, and proactive issue resolution
Computer literacy, including Excel and Microsoft Word
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
WiFi and satellite internet are not permitted
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Must provide own workspace furniture
Ability to use multiple monitors and navigate multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to access secure systems such as VPN and EHR portals
Ability to follow computer and password security practices and recognize suspicious emails or links
Ability to troubleshoot common technical issues and contact IT when needed
Openness to learning new skills
High school diploma or G.E.D.
Preferred: 2–4 years of experience as a medical assistant, office assistant, or claim processor
Preferred: CEC/GPS or MedCompass experience

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
CVS Health bonus, commission or short-term incentive program in addition to base pay